[NCCDPHP] Pilot Testing of State-Level Prevalence Estimation Using a YouGov Internet Panel

[NCCDPHP] Cognitive Testing and Pilot Testing for the National Center for Chronic Disease Prevention and Health Promotion

Documents and Forms

Document Name Document Type
Form 0920-1291 [NCCDPHP] Pilot Testing of State-Level Prevalence Estimation Using a YouGov Internet Panel Form and Instruction
0920-1291 CDC Questionnaire - BRFSS subset Attachment 1 CDC questionnaire BRFSS subset.docx Form and Instruction
0920-1291 Panel Core Questions Attachment 2 core questions.docx Form and Instruction
Attachment 3 consent.docx Consent Statement/Form IC Document
Attachment 4 YouGov panel recruitment and survey methodology-combined.pdf YouGov Recruitment/Methodology IC Document
Pilot Testing of State-Level Prevalence Estimation YouGov.docx 0920-1291 GenIC Request Template IC Document

Information Collection (IC) Details

IC Title:	[NCCDPHP] Pilot Testing of State-Level Prevalence Estimation Using a YouGov Internet Panel	Agency IC Tracking Number:	0920-1291-23GP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1291	CDC Questionnaire - BRFSS subset	Attachment 1 CDC questionnaire BRFSS subset.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1291	Panel Core Questions	Attachment 2 core questions.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,200	2,200
Annual IC Time Burden (Hours)	550	550
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Statement/Form	Attachment 3 consent.docx	07/05/2023
YouGov Recruitment/Methodology	Attachment 4 YouGov panel recruitment and survey methodology-combined.pdf	07/05/2023
0920-1291 GenIC Request Template	Pilot Testing of State-Level Prevalence Estimation YouGov.docx	07/05/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.